043. Magnetic Resonance Imaging May Be Unessential in the Prediction of Operative Cervical Trauma

Authors: Michael M. McDowell, MD

Evaluation of cervical SPINE injury (CSI) in the pediatric trauma patient continues to vary widely across institutions due to a lack of evidence-based recommendations. While MRI is useful for describing soft tissue injury, overuse of MRI in the evaluation of CSI may result in unnecessary cost burden placed on families with no added benefit to the patient.Methods: A post-hoc analysis of a prospectively collected database of pediatric patients sustaining trauma from 2010-2019 was screened for patients having been assessed for cervical SPINE injuries. Patients without cervical SPINE MRI as part of the work-up were excluded. Univariate analysis was performed comparing predictors for surgical intervention and for long-term patient outcomes. Multivariate analysis via logistic regression was performed on appropriate variables with a p-value < 0.2.
Twenty-eight of 260 (10.7%) patients required surgery for cervical instability or injury secondary to trauma subsequently, including 16 procedures for ligamentous injury and 12 for fracture. All 28 patients had evidence of either a persistent neurological deficit (11; p < 0.001) and/or an abnormal CT finding (23; p < 0.001), of which 9 had evidence of soft tissue injury alone. MRI findings of soft tissue injury were present in 27 patients (p < 0.001), with a median of 3.5 different soft tissue findings (p < 0.001). On multivariate analysis, persistent deficit (OR 6.01; p = 0.003), positive CT findings (OR 5.2; p=0.013), and positive MRI findings (OR 16.3; p < 0.0001) were independently predictive of surgical intervention.
While predictive in its own right, MRI appears to provide limited additional operative predictive value in the absence of neurological deficits and CT finding of SPINE injury. When a reliable neurological exam is available and the patient has received a cervical CT scan, MRIs should be used primarily as part of pre-operative planning rather than routinely as an operative screening tool.